Introduction

The public health system in England is now radically different from all other decades that have been reported on so far in this book.

New public health system for England from 2013

The Coalition government came to power in May 2010 with an agenda for radical reform of both the health service and the public health system. Driving forces were the stated intention to focus on outcomes rather than targets, increase choice and competition, give greater control to local clinicians, and ensure transparency of data. For public health, the aims were to give local communities greater control over public health budgets and to ensure that General Practitioners (GPs) were more engaged in the prevention agenda and tackling health inequalities. Despite the desire to reduce the overall size of the state sector, implementation has entailed considerable change and upheaval in both health service and public health administration and the creation of an extremely complex new system with a substantial number of new public sector organisations.

The reforms came into operation on 1 April 2013. The National Health Service (NHS) White Paper proposals (DH, 2010a) changed the structure for the commissioning of health care and thereby substantially increased GP engagement in commissioning. The 152 Primary Care Trusts (PCTs), previously responsible for commissioning the whole of health care, and 10 Strategic Health Authorities (SHAs), providing performance oversight, were disbanded and replaced by a system of over 200 GP-led Clinical Commissioning Groups (CCGs). The latter were to be charged with commissioning the bulk of secondary care health services, working within and supported by a new structure called NHS England (also known as the NHS Commissioning Board), a Special Health Authority with a budget of £80 billion and operating as a single system through 27 Area Teams (ATs) across the country.